Crowded, noisy mother-baby unit to be replaced

Fletcher Allen plans $15.8 million project to provide mothers and newborns with state-of-the-art accommodations for their first hours together

Oct. 19, 2013

New parents Nicole Robjoy and husband Andy of St. Albans give their son Jacob, 4, a chance to hold his new baby sister Jillian at Fletcher Allen Health Care in Burlington. The wing of the hospital dedicated for moms and their newborns is one of the oldest sections of the facility. / RYAN MERCER/FREE PRESS

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Free Press Staff Writer

New parents Nicole and Andy Robjoy of St. Albans, their son Jacob, 4, take turns holding newborn Jillian at Fletcher Allen Health Care in Burlington. The hospital is planning to construct a new wing for moms and babies with updated facilities and larger rooms. / RYAN MERCER/FREE PRESS

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When Nicole Robtoy gave birth to her daughter, Jillian, last Monday, she and her husband, her mother and her mother-in-law, nurses and doctors, all occupied a corner room with a spectacular view of Lake Champlain in the 10-year-old birthing center at Fletcher Allen Health Care in Burlington.

Shortly after her baby was born, Robtoy and Jillian had to move to the medical center’s old-style mother-baby unit — located two floors down and three buildings away. “They clean you up and cover you up,” she said, adding, “It’s quite a ways to travel.”

Robtoy said she has been lucky. For both her son, born nearly five years ago, and now her daughter, she had a room to herself on the mother-baby unit even though it was set up for two patients. “If there had been somebody else, it would have been miserable.”

Even so, she described the room as cramped when her husband and son visited.

Patient satisfaction surveys show many new mothers share Robtoy’s view of the unit. Fletcher Allen has repeatedly scored “well below national benchmarks” because of the crowded, noisy rooms in its mother-baby unit.

An independent survey conducted by a health care analytics firm between Aug. 1, 2011 and July 31, 2012 found significant dissatisfaction. One mother commented, “McClure 7 (the birthing center) was great. Shepardson 5 (the mother-baby unit) was like a totally different hospital."

Fletcher Allen plans to remedy the shortcomings of its antiquated unit by moving it to a space near the birthing center that will be completely revamped to create a state-of-the-art mother-baby unit. The project will take more than a year to complete.

The Green Mountain Care Board approved the $15.8 million project last week. The five-member board concluded that the cost of the project fell within industry standards and would not result “in an undue increase in the cost of medical care.” It also agreed that the medical center had made a case that the project was needed.

Board Chairman Al Gobeille said the project easily met the three requirements for new capital expenditures: need, financing that won’t result in rate shock and a design that meets medical architectural standards.

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“I walked around up there,” Gobeille added. “It took me five minutes to say we should do this.”

The need

In its application for a certificate of need for the project, hospital officials reported that more than 2,000 babies are born each year at the medical center and “caring for mothers and babies is a core service.”

“However, despite Fletcher Allen’s important role as a provider of labor and delivery services, its post-partum inpatient facilities are more than 50-to-70 years old and do not conform to contemporary health care standards due to their age, design, size and remote location from related services such as the birthing center and the neonatal intensive care unit.”

Dr. Ira Bernstein, medical leader for women's health care services at Fletcher Allen, said the separation of the birthing center and mother-baby unit took place in 2004 when a new floor was added to the McClure building to accommodate a modern birthing center.

"I think everyone recognized this as a limitation," Bernstein said of the decision to separate the birthing center from the ward where mothers would move after giving birth. Still, he said the hospital had yet to develop a plan to rejoin the units when the birthing center opened on Mother’s Day 2004.

Bernstein called relocation of the mother-baby unit long overdue.

The project will do more than raise patient satisfaction scores, according to the application. The new unit will offer most patients single rooms, with double occupancy anticipated only 1 percent of the time.

The move will make it easier for babies to stay in the rooms with their mothers, the application said, which will “provide a better environment to support breast feeding and mother-baby bonding.

“The higher rate of single occupancy will reduce the risk of hospital acquired infections, falls and medication errors,” officials also argued in the certificate of need application.

"There are issues of safety, although I can't say anything bad has happened," Bernstein noted.

The moments of greatest anxiety over the past decade, he said, have been the rare obstetrical emergencies involving mothers hospitalized on the mother-baby unit because they are experiencing high-risk pregnancies. Forty percent of the unit’s use is by high-risk expectant mothers.

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During obstetrical emergencies, Bernstein said, staff scurry to clear corridors and hold elevators when they need to rush expectant mothers from the unit to the birthing center.

A nurse's perspective

“This has been a project the hospital has known they have needed for a long time,” said Khris Vroegop, nurse manager of the mother-baby unit.

Part of the unit was built in 1941 with the rest added in 1960. The unit has 33 beds in 21 rooms. Nine rooms lack toilets and showers. Patients share rooms 27 percent of the time.

Vroegop said the room setup makes it challenging for nurses to teach breast feeding, which can involve significant disrobing. “It’s hard to meet patient needs in the small space,” she said, when there is another patient, baby and family on the other side of a curtain.

The trip from the birthing center is another concern, Vroegop said. It involves moving from the farthest west building at the medical center to the farthest east building along busy corridors, she said. “It really bothers some moms. It is like becoming this spectacle.”

The nurse manager noted germ and temperature concerns, too, for the babies as they are transported. “Losing heat is a big deal for a newborn,” she said.

Weighing options

The hospital considered several ways to update the unit before settling on relocation, according to David Keelty, director of facilities planning and development.

Renovating the existing unit and new construction were more expensive than the relocation plan approved by the Green Mountain Care Board.

“We are getting 95 percent of what we need by reusing a facility,” Keelty said. “We need to fix this problem in a cost effective manner.”

It’s a two-step project. First, renovated space has to be constructed for the clinical research center that occupies Baird 7, which is where the mother-baby unit will move.

That phase will cost $4 million and begin in December, Keelty said. The University of Vermont contributed $1 million toward the research center's relocation.

Bernstein, who is senior associate dean for research at the College of Medicine at the University of Vermont, said having a clinical research center in the hospital allows human subject research.

The research center will move to the second floor of Shepardson, which has been vacant since the radiation oncology unit moved. Bernstein noted it will be closer to the medical center's outpatient area and more convenient for research participants.

"We are happy to move to that location," Bernstein said.

Once the research center moves, Baird 7 will be gutted and reconstructed to create a unit with a 10-12-basinet nursery, 28 beds in 25 large rooms for mothers and babies, and three smaller rooms for use by “boarding” mothers who have been discharged but want to remain near their babies who are still hospitalized.

The price tag for this portion of the project is $11.8 million.

Fletcher Allen told regulators it could pay for the project from “working capital” without raising rates or borrowing. A fund drive has been launched with a goal of raising $3 million toward the cost of the new unit.